Functional anatomical hepatectomy guided by indocyanine green fluorescence imaging in patients with localized cholestasis: Report of four cases

BACKGROUNDLiver cancer is a malignant tumor with a high incidence. At present, the most effective treatment is laparoscopic hepatectomy (LH). Indocyanine green fluorescence imaging (ICG-FI) has become an important tool in LH, and the most common fluorescent types of tumors are total fluorescence, partial fluorescence, and rim fluorescence.CASE SUMMARYWe presented four cases of LH guided by ICG-FI in which we also observed the fourth special fluorescent type. When the tumor or intrahepatic stone compresses the adjacent bile duct to cause local cholestasis, the liver segment or subsegment with obstructed bile drainage will show strong fluorescence. Complete removal of the lesion together with the fluorescent liver parenchyma may help reduce the risk of tumor or stone recurrence.CONCLUSIONThis type of partial fluorescence can indicate local biliary compression, and the resection method is related to bile drainage, which may be called functional anatomical hepatectomy and ensures radical resection of the lesion.     

孕妇外周血NKT细胞水平与妊娠期肝内胆汁淤积症发病及病情关系

目的:探究孕妇外周血自然杀伤T(NTK)细胞水平与妊娠期肝内胆汁淤积症(ICP)发病及病情严重程度相关性。方法:选择2016年3月1日-2018年3月1日本院就诊的ICP患者52例(ICP患者组),根据ICP严重程度分为轻度ICP组(n=28)和重度ICP组(n=24),同时随机选择孕周相当的健康产前检查孕妇52例(健康孕妇组),比较各组外周血单个核细胞(PBMC)中NKT细胞水平,分析NKT细胞水平与ICP发生发展相关性。结果:ICP患者组外周血PBMC中NKT细胞含量高于健康孕妇组(P<0.05)。对ICP患者组和健康孕妇组外周血PBMC给予不同刺激物培养后,均显示出NKT细胞含量在正常组与空白组无差异(P>0.05),而在植物血凝素(PHA)组、ICP组、正常组依次降低(P<0.05)。重度ICP组外周血PBMC中NKT细胞含量高于轻度ICP组(P<0.05),NKT细胞含量与ICP病情严重程度呈正相关关系(P<0.05)。结论:ICP发生及进展与孕妇外周血NKT细胞水平呈正相关关系,监测NKT细胞水平可为诊断ICP提供新思路。     

脐动脉多普勒血流测定在肝内胆汁淤积症的应用

目的：评价脐动脉多普勒血流测定（Ｓ／Ｄ）与无钢荷试验（ＮＳＴ）在妊娠期肝内胆汁淤积症（ＩＣＰ）中的应用价值。方法：应用Ｓ／Ｄ与ＮＳＴ对孕龄为３５～４０周１５７例ＩＣＰ患者进行动态监测,并对新生儿Ａｐｇａｒ评分和羊水粪染的情况进行比较。结果：脐动脉血流Ｓ／Ｄ〈３、ＮＳＴ≥７分,胎儿预后良好;脐动脉血流Ｓ／Ｄ≥３、ＮＳＴ〈７分,胎儿预后不佳,两者差异有显著性（Ｐ〈０．００５）。结论：脐动脉多普勒血流检测弥补单纯ＮＳＴ对ＩＣＰ患者胎儿预后判断的不足,提高临床诊断准确率。     

妊娠肝内胆汁淤积症孕妇血及脐血中一氧化氮水平与胎儿脐血流的关系

目的　了解妊娠肝内胆汁淤积症 (ICP)时 ,孕妇血及脐血中一氧化氮 (NO)水平与胎儿脐动脉血流的关系 ,以进一步探讨ICP时胎盘循环阻力增高的原因。方法　对 35例ICP孕妇 (ICP)组 )及 32例正常孕妇 (对照组 ) ,用镉还原显色法测定母血及脐血NO水平 ;超声多普勒测定胎儿脐血流S/D值。结果　ICP组母血、脐血NO水平均明显低于对照组 (P <0 .0 1,P <0 .0 1) ;两组母血、脐血NO水平均有相关关系 (r =0 .5 481,r =0 .82 0 6 ,P<0 .0 1,P <0 .0 1) ,ICP组脐动脉血流S/D值明显高于对照组 (P <0 .0 1) ,母血、脐血NO水平与S/D值呈负相关(r =- 0 .34 15 ,r=- 0 .42 6 1,P <0 .0 5 ,P <0 .0 1。结论　ICP时母血、脐血NO水平降低对胎儿—胎盘循坏阻力增加有重要的作用     

梗阻性黄疸与肠粘膜屏障功能的实验研究

目的 了解梗阻性黄疸时小肠粘膜的病理改变。方法 无菌条件下结扎大鼠总胆管,取末端回肠观察其组织学改变,测量小肠粘膜的绒毛高度,绒毛面积和肠粘膜厚度;计算内脏细菌移位率。结果 在光镜下观察到总胆管结扎组肠粘膜萎缩,绒毛水肿,部分上皮细胞脱落;绒毛平均高度、绒毛平均面积和粘膜平均厚度减少。在电镜下观察到微绒毛稀疏,排列紊乱,内质网数目少且结构不完整;线粒体数目少,轻度肿胀,膜不清楚,嵴少而乱,内有空泡     

N-nitro- -arginine methylester is protective against ethanol-induced gastric damage in cholestatic rats

In this study the effect of nitric oxide (NO) synthesis inhibition on ethanol-induced gastric damage was evaluated in bile duct-ligated, sham-operated and unoperated rats. The animals were injected intraperitoneally with saline, -arginine (200 mg/kg) or N^G-nitro- -arginine methylester ( -NAME) in doses of 5, 15 and 30 mg/kg, 30 min before ethanol administration. The animals were killed 1 h after ethanol administration and their stomachs were removed for measurement of gastric mucosal damage. The results showed that -NAME significantly enhanced the development of gastric mucosal lesions in sham-operated and unoperated rats, while in bile duct-ligated animals, -NAME decreased and -arginine enhanced the potentiation of ethanol-induced gastric mucosal damage. The plasma level of nitrite and nitrate was also measured and was significantly higher in bile duct-ligated rats than in control groups. The results suggest that inhibition of NO synthase with -NAME has different effects on ethanol-induced gastric damage in cholestatic groups and in normal rats and that these effects can be explained by overproduction of NO in bile duct-ligated animals.     

Proliferation of intrahepatic bile-duct epithelium in biliary atresia

Proliferating cell nuclear antigen (PCNA) and transforming growth factor (TGF) are considered as markers of cell proliferation. The expression of PCNA and TGF was evaluated immunohistochemically using anti-PCNA antibody and TGF in 31 patients with biliary atresia (BA) (15 jaundice-free and 16 with persistent jaundice) and 6 control infants. The labeling indices (LI) for PCNA- and TGF-positive bile-duct epithelium in BA were 14.1±14.0% and 51.4±33.7%, respectively, which was significantly higher than in the controls (P <0.01). In BA, the number of PCNA-immunoreactive cells was higher in the peripheral bile ductules than in the central bile ducts of the portal tract (P <0.01). LI was not related to patient age at the time of hepatic portoenterostomy in two groups divided at the age of 60 days. Patients in the persistent jaundice group had greater expression of PCNA and TGF (21.7±16.0% and 76.9±20.7%, respectively) compared to those in the jaundice-free group (6.0±2.7% and 24.3±20.9%, P <0.001). PCNA and TGF expression in the bile-duct epithelium of the portal tract was closely related to prognosis in BA patients, and thus could be useful as a prognostic marker.     

Hepatitis and cholestasis in infancy: clinical and nutritional aspects

A major complication of cholestasis is fat malabsorption related to decreased intestinal bile acids, which leads to malnutrition and fat-soluble vitamin deficiency. The impaired excretion of bile acids leads to a low intraluminal micellar concentration that causes long-chain triglyceride lipolysis and absorption to be ineffective. Medium-chain triglycerides (MCTs) are more readily absorbed when there are low concentrations of bile acids and therefore are a good source of fat calories; MCTs can be administered as MCT-containing formulas. In those children who are unable to take sufficient calories by mouth, it is important to start nocturnal enteral feeding to improve nutritional status. In infants with cholestasis, the absorption of fat-soluble vitamins (A, D, E and K) that require bile acids is also impaired, and supplementation is mandatory. Vitamin K deficiency may be responsible for hypoprothrombinaemia, which may lead to bleeding diathesis, Vitamin K (phytomenadione) should therefore be promptly administered intravenously, at a dose of 1 mg. Chronic vitamin E (α-tocopherol) deficiency is associated with a progressive neuromuscular syndrome that can cause cerebellar ataxia, areflexia and peripheral neuropathy. Supplements are given orally in doses of 3–5 times the normal requirement if cholestasis is incomplete. In complete cholestasis, supplements must be given intramuscularly at monthly intervals. In infants who fail to thrive, dietary supplements of carbohydrate polymers and MCTs are required.     

Cholestasis in newborn infants with perinatal asphyxia

Abstract Objective : The aim of this study was to characterize the liver involvement in infants who have both neonatal asphyxia and neonatal cholestasis. Methods : We describe four asphyctic newborn infants (three born at term) who developed early (age 3.8 ± 2.1 days) intrahepatic neonatal cholestasis and in whom tests for causes of neonatal liver damage were negative. Results : The clinical picture and course were benign and similar to that of sporadic "idiopathic" neonatal hepatitis. Clinical signs and abnormal liver function tests tended to normalize within the first year of life in all. Conjugated bilirubin became normal at 6 months after the onset of cholestasis, while liver enzymes tended towards normal values thereafter, within 1 year of follow-up. Liver biopsy (taken in one patient) showed a typical picture of giant cell hepatitis; ultrastructure was nonspecific. Significance : Our results suggest that isolated asphyxia should be taken into account as a potential causal factor in term or pre-term asphyctic newborns who develop early "idiopathic" neonatal cholestasis.     

小儿哮喘甲襞微循环及血液流变学观察

小儿哮喘甲襞微循环及血液流变学观察李荣，刘昕，蒋红雨，曹序茂１９９４年３月～１９９５年８月，我们通过对３２例哮喘患儿急性发作期及缓解期甲襞微循环和血液流变性的对比观测，探讨采用中医活血化瘀疗法防治小儿哮喘的可行性。临床资料根据全国儿科哮喘协作组１９９...